Janelle Christensen, PhD, MPH (AAGE member since 2006). Janelle’s research interests lie at the intersection of disaster management and aging studies, exploring how community dwelling families respond to emergency preparedness and disaster planning while simultaneously providing care for family members with Alzheimer’s disease. She completed both PhD in Applied Biocultural Medical Anthropology and a Masters in Public Health (MPH) at the University of South Florida and has done Socio-legal research in intentional communities (Camphill Communities) based on the care of individuals with developmental disabilities in both Germany and the United States while completing her MA in Sociology of Law. Janelle is currently working as a Program Data Analyst for the Health Information program at Palm Beach State College.
When Hurricane Katrina struck New Orleans1 in 2005, the death tolls were overwhelmingly among those over 65 years of age.2 Many were frail elders who were not prioritized during hospital evacuations.3 Others died in their homes, alone. Many were separated from families and stranded as the area struggled to rebuild.4
I am an anthropologists who has worked with aging populations in hurricane prone areas, specifically individuals with Alzheimer’s disease and related dementias and their caregivers in South Florida.5,6 For many anthropologists, climate change is not an abstract concept that may or may not affect humanity in the far off future. When models show that a warming climate and warmer oceans fuel more powerful hurricanes 7,8 and one lives in a coastal area, as I do, climate change is not far away. As Crate and Nuttall (2009) poignantly explain,9 climate change has an immediate impact on many groups around the globe, from the Sahara to the Arctic. As people living at the margins of society, or at the margins of habitable land, struggle to adapt to the symptoms of a disrupted climate, their stories are documented in the field notes and writings of anthropologists who work with these groups. To the people contending with the results of a changing climate, it is not a hypothetical: climate change is real, immediate, and personal. Likewise, when one works with and cares about the very people who are likely to be considered among the most expendable 3,10 should an inevitable hurricane hit one’s area, there is cause for concern.
In 2012, Hurricane Sandy struck New York and New Jersey. While the death toll was much lower than in Louisiana and Mississippi during Hurricane Katrina, of those who died as a direct or indirect result of Hurricane Sandy, most were over the age of 60.11 Decisions made by governors, hospital and nursing home administrators, and private citizens all played a role in the disproportionate death tolls during both Hurricane Katrina and Hurricane Sandy.1
To many, this is not surprising. As Fjord (2007) points out, the sick, disabled, and elderly are “the expected dead”.12 While elders might be cared for well enough under normal circumstances, all too often during a disaster, many of the most vulnerable are deprioritized. During Hurricane Katrina, buses that had been contracted for nursing home evacuations were commandeered by Federal agencies for other purposes.1314 Nursing homes were not often regarded as essential facilities and therefore, are not prioritized for power restoration after a storm.15At least two hospitals in New Orleans (Memorial Hospital and Lindy Boggs) did not evacuate many of the patients who needed the most intensive care. 10,16 Though neonates were evacuated after the storm and the ambulatory could be evacuated by boat when the hospital flooded, those who were elderly were left to die in the oppressive heat to which the elderly are particularly vulnerable. At both of these hospitals, morphine was administered in potentially lethal doses to many of the elderly patients (though charges of homicide were later dropped).3
Sheri Fink describes the challenging ethics that accompanied the allocation of scarce medical resources before Hurricane Sandy hit New York in her book 5 Days at Memorial. She notes that many of the lessons supposedly learned during Hurricane Katrina had failed to translate to prepared hospitals in New York as the storm approached.10 Generators were still located in flood-prone basements. Administrators and staff met to decide who should be kept on the limited number of electrically powered respirators should there be a prolonged loss of power. The protocol for deciding who is the most worthy of life-saving equipment and procedures is rarely established and clear. The allocation goals are supposedly to serve the “greatest good” but, as Fink asks, “what does the “greatest good” mean when it comes to medicine? Is it the number of lives saved? Years of life saved? Best ‘quality’ years of life saved? Or something else?”3 These questions hint at another: Should the younger populations be prioritized before the elderly? In answer to this, Fink cites a response from a woman participating in a focus group.
“If a significant generation, if the senior citizens were cut in half that would alter our society. That means that, you know, just like you definitely don’t want your child to die, people don’t want to be grandmother-less, people don’t want to be grandfather-less… So, I am just a little concerned about the aftermath of just giving it to the youngest person.”3
Anthropologists such as Anthony Oliver-Smith and Susanne Hoffman have long argued that disasters act as spotlights that shine on societies’ collective values.17,18 Recent hurricanes have forced us to ask, “To what extent do our elders matter to us in the United States?” Certainly, not all people over the age of 65 are frail and ill. Many are strong and healthy. Others are wealthy and can purchase assistance if needed. However, for those that are unable to simply get in a car and evacuate, who rely on others to assist them with their wellbeing, and have few resources, how do we ensure that they are not left behind? How do we resist the mechanisms in place that seem to deprioritize those with the most lived experience because they are the most inconvenient to serve during a disaster?
(In the next post of this series Janelle will look at how these questions can help us understand the lives of older people in the Lake Okeechobee region of Florida, where she conducted ethnographic research)
1. A Failure of Initiative: Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina. Washington, D.C.; 2006:1–379.
2. Brunkard J, Namulanda G, Ratard R. Research Hurricane Katrina Deaths, Louisiana, 2005. Disaster Med Public Health Prep. 2008:1–9.
3. Fink S. Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital. New York, New York: Crown; 2013:576.
4. Adams V, Kaufman SR, Hattum T Van, Moody S. Aging Disaster: Mortality, Vulnerability, and Long-Term Recovery Among Katrina Survivors. Med Anthropol Q. 2011;30(3):247–270. doi:10.1080/01459740.2011.560777.Aging.
5. Christensen JJ. Hurricane Preparedness of Community-Dwelling Dementia Caregivers in South Florida by. 2012:1–354.
6. Christensen JJ, Richey ED, Heide Castañeda. Predictors of Hurricane Evacuation of Community-Dwelling Families Affected by Alzheimer’s. Am J Alzheimers Dis Other Demen. 2013.
7. Trenberth K. Warmer Oceans, Stronger Hurricanes: Evidence is mounting that global warming enhances a cyclone’s damaging winds and flooding rains. Sci Am Mag. 2007;297(1):44–51.
8. Emanuel K. Increasing destructiveness of tropical cyclones over the past 30 years. Nature. 2005;436(7051):686–8. doi:10.1038/nature03906.
9. Crate SA, Nuttall M. Introduction. In: Crate SA, Nuttall M, eds. Anthropology and Climate Change: From Encounters to Actions. Walnut Creek, California: Left Coast Press; 2009:9–38.
10. Fink SL. Rationing Medical Care: Health Officials Struggle With Setting Standards. ProPublica. December 21, 2009.
11. Deaths Associated with Hurricane Sandy October–November 2012. Morb Mortal Wkly Rep. 2013;62(20):393–397.
12. Fjord L. Disasters , Race , and Disability : [ Un ] Seen Through the Political Lens on Katrina. J Race Policy. 2007;3(1):46–66.
13. Hurricane Summit Proceedings. 2006:100. Available at: http://www.ahcancal.org/facility_operations/disaster_planning/Documents/HurricaneSummitHartfordReport.pdf.
14. Caring for Vulnerable Elders During a Disaster : National Findings of the 2007 Nursing Home Hurricane Summit. 2007:1–62.
15. Hyer K, Brown LM, Christensen JJ, Thomas KS. Weathering the storm: challenges to nurses providing care to nursing home residents during hurricanes. Appl Nurs Res. 2009;22(4):e9–e14. doi:10.1016/j.apnr.2008.11.001.
16. Gray B, Herbert K. Hosptials in Hurricane Katrina: Challenges Facing Custodial Institutions in a Disaster.; 2006:28.
17. Hoffman SM, Oliver-Smith A. The Angry Earth: Disaster in Anthropological Perspective. (Hoffman SM, Oliver-Smith A, eds.). New York: Routledge; 1999:350.
18. Hoffman SM, Anthony Oliver-Smith. Catastrophe & Culture: The Anthropology of Disaster. (Hoffman SM, Oliver-Smith A, eds.). Santa Fe, New Mexico: School for Advanced Research Press; 2002:316.